Jules-Gabriel-François Baillarger

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French neurologist and psychiatrist, born March 25, 1815, Montbazon, département Indre-et-Loire, west central France; died December 31, 1890.

Biography of Jules-Gabriel-François Baillarger

Jules-Gabriel-François Baillarger was born of a middle-class family in Montbazan, Indre-et-Loire. His education was entrusted to an old priest who was, however, a better apiarist than scholar. Baillarger studied medicine at Paris under Jean Étienne Dominique Esquirol (1772-1840), and already while still in training he worked as an intern at the Charenton asylum for the mentally ill. He was conferred doctor of medicine in 1837 with a thesis entitled Du siége de quelques hémorrhagies méningées. Three years later, in 1840 he was appointed to the Salpêtrière, but soon gave up his position to become one of the directors of a mental asylum in Ivry that had been established by his teacher, Esquirol. In 1842 the Académie de médecine awarded him a prize for his work on hallucinations.

In 1843, with François Achille Longet (1811-1871), Laurent Alexis Philibert Cerise (1807-1869), and Jacques-Joseph Moreau (1804-1884) he founded the journal Annales médico-psychologiques du système nerveux, in which he published many of his papers. This is still published and is therefore the oldest journal of psychiatry in the world. Later he was the moving spirit in establishing the Société médico-psychologique and the Association mutuelle des médecins aliénistes.

Baillarger was vitally interested in hospital administration, the care of prisoners, deficiency disorders and cretinism, and made the usual run of mental hospital observations. In 1865, according to André Ombrédane, Baillarger pointed out that patients with aphasia had lost the power of voluntary speech but nevertheless retained certain automatic expressions that were not always employed correctly. This contribution was recognized by John Hughlings Jackson who called it "Baillarger's principle."

Baillarger's interests were mainly clinical, and his descriptions of behaviour in various types of mania, melancholia and general paralysis were true to form but not really enlightening. He described the manic-depressive cycle and the stupor of melancholia, and he noted the unequal pupils in dementia paralytic and their occasional association with locomotor ataxia. From his description of these disorders, however, it must be concluded that as a clinician he was working in etiological darkness.

Outstanding among his works on psychiatry was that on hallucinations – which brought him the Prix de l'Académie in 1842. According to Zilboorg and Henry, Baillarger "was the first to sense that hallucinations are what we would call today spontaneous results of a psychological reaction; he called them 'involuntary'. He also studied the role of the state which is intermediary between that of being asleep and that of being awake, at which time normal people have hallucinatory experiences, now called 'hypnagogic.' "

In 1875 he was offered the first chair of psychiatry in France. He declined because he felt that he was too old for the job, which was finally given to Benjamin Ball (1834-1893) in 1877.

At the age of thirty, while still engaged in clinicopathologic correlations, Baillarger presented in 1840 a paper before the Académie royale de médecine on the structure of the grey matter of the cortex. Francisco Gennari (1750-1797), Félix Vicq d'Azyr (2748-1794) and Samuel Thomas Soemmerring (1755-1830) had noted white lines in the cortex with naked eye by gross dissection; Baillarger, on the other hand, made his advances by cutting thin slices of fresh cortex, placing them between two pieces of glass, and observing them with the aid of a light held behind them. By this means he divided the cortex into six layers of alternate white and grey laminae. He was able to satisfy himself that the white lines seen by Francisco Gennari in the occipital area could be traced in all parts of the cortex, although they were far less conspicuous anteriorly than posteriorly. This continuation of Gennari's line has therefore come to be known as the "external line or white stripe of Baillarger". Baillarger's stripes attracted much attention and as late as 1907, Elliot Smith – who at that time was in Cairo – examined freshly cut slices of brain with a hand lens, and taking the stripes as landmarks, was able to distinguish some forty sharply delimited cortical areas.

In addition to being the first to demonstrate that the cortex is made up of layers – "resembling a grey ribbon with three white bands in it" – Baillarger was also the first to show that fibres connected the cortex with the internal white matter. "At the summit of the convolutions," he wrote, "the white matter is entirely united to the grey matter by many fibres. A simple juxtaposition of these two components is thus inadmissible."

He also demonstrated that the surface of the human brain in comparison to its own volume is less than that in smaller animals, and that as a compensatory measure larger brains undergo greater fissuration than smaller ones – in short that the difference in external form of lissencephalic and gyrencephalic brains is explicable on the basis of the geometric law of volumes, that the volumes increases as the cube of the diameter while the surface increases at the square. This observation has stood the test of time.

Baillarger was a courageous man, which he proved during the epidemics of cholera in 1849 and 1865). To him Ulysse Trélat (1828-1890) and Valentin Jacques Joseph Magnan (1835-1916) owed their deliverance from cholera, for it was he who personally nursed them back to health.

An energetic, sociable person, Baillarger was noted as a teacher and given to philantropy, for example, he instituted a special kind of insurance for psychiatrists and their families.

He left a large number of publications, mostly case studies in the field of psychiatry.

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